Clindamycin Dosage for MRSA Wound Infections in Adults
For adults with normal renal function, clindamycin should be dosed at 600 mg every 8 hours for MRSA wound infections. 1
Dosing Recommendations
Adult Dosing
- Intravenous (IV) administration: 600 mg every 8 hours 1
- Oral administration: 300-450 mg every 6-8 hours (when transitioning from IV therapy)
Duration of Therapy
- Uncomplicated skin and soft tissue infections: 5-10 days
- Complicated skin and soft tissue infections: 7-14 days 2
- Treatment should continue until clinical improvement is observed, typically within 7-14 days
Clinical Considerations
Efficacy and Resistance
- Before initiating clindamycin, ensure local MRSA resistance rates are low (<10%) 1
- Always perform susceptibility testing to confirm clindamycin sensitivity
- Check for inducible clindamycin resistance using D-test, as this can lead to treatment failure 3
- Clindamycin has shown comparable efficacy to vancomycin in treating MRSA skin infections when the organism is susceptible 4
Adjunctive Therapy
- Surgical drainage of abscesses is the mainstay of therapy and should be performed whenever feasible 1
- In 97% of cases, drainage (either spontaneous or procedural) is crucial for successful treatment 5
Monitoring
- Assess clinical response at 48-72 hours after initiating therapy
- Complete resolution should be expected within 7 days in most cases 5
- Monitor for adverse effects, particularly Clostridium difficile colitis 2
Special Situations
- For severe infections or those with systemic involvement, consider combination therapy with rifampin (600 mg daily or 300-450 mg twice daily) 1
- For pediatric patients, the recommended dose is 10-13 mg/kg/dose every 6-8 hours (total daily dose of 40 mg/kg/day) 1
Prevention of Recurrence
- Implement hygiene measures including covering draining wounds and regular handwashing
- Clean high-touch surfaces with appropriate cleaners
- Consider decolonization strategies for recurrent infections:
- Nasal mupirocin twice daily for 5-10 days
- Chlorhexidine body washes for 5-14 days 2
Potential Pitfalls
- Failure to perform susceptibility testing before initiating therapy
- Overlooking inducible clindamycin resistance, which can result in treatment failure
- Inadequate surgical drainage of abscesses
- Insufficient duration of therapy for complicated infections
- Not monitoring for C. difficile colitis, a potential adverse effect of clindamycin
Remember that close follow-up and proper wound care are essential components of successful treatment, regardless of antibiotic choice 5.